Healthcare satisfaction at the intersections of sexual orientation and race/ethnicity

OBJECTIVES

Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity.

DESIGN

Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities.

RESULTS

Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group.

CONCLUSION

While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.

Methodological strategies to engage young black and Latino heterosexual couples in sexual and reproductive health research

BACKGROUND

Approaches that move beyond individuals and target couples may be an effective strategy for reducing sexual and reproductive health (SRH) disparities among adolescents and young adults (AYA). However, few researchers have attempted to recruit couples due to feasibility and methodological issues. This study aims to enhance implementation and methodological approaches to successfully engage heterosexual Black and Latino adolescent and young adult (AYA) couples in sexual reproductive health (SRH) research.

METHODS

We developed a four-step approach to systematically engage AYA couples in a qualitative study examining factors that influence uptake of combination HIV prevention methods: 1) understanding barriers and facilitators to engaging AYA couples, (2) identifying AYAs living in geographic areas of HIV vulnerability, (3) recruiting and screening AYA couples, and (4) scheduling and completion of the interview session.

RESULTS

Black and Latino youth aged 16 to 24 and their opposite sex romantic were recruited in the South Bronx, New York from September 2017-May 2018. Three hundred and seventy-two men and women completed screening procedures to determine eligibility for the index participant; 125 were eligible and enrolled into the study. Forty-nine nominated partners (NPs) participated in screening procedures and enrolled into the study. A total of 49 couples enrolled into the study; 23 couples completed study activities.

CONCLUSIONS

Developing a systematic recruitment plan aided in successfully engaging Black and Latino heterosexual youth. Nevertheless, barriers to study enrollment remained including locating eligible IPs and screening of the NP. Targeting both young men and women was an effective recruitment strategy. Moreover, dyadic strategies that allow for simultaneous interaction with both couple members may be a beneficial strategy to couples' study enrollment and completion of study activities.

Following Their Lead? Connecting Mainstream Media Use to Black Women's Gender Beliefs and Sexual Agency

Although media exposure has emerged as a significant predictor of consumers' sexual decision making, less is known about the mechanisms involved and about the dynamics of these relations for adults, in general, and for African American adults, in particular. To address these gaps, we used structural equation modeling (SEM) to test whether heterosexual Black women's endorsement of traditional gender and sexual roles mediates connections between their consumption of four mainstream media (music videos, reality TV programming, movies, and women's magazines) and three dimensions of their sexual well-being (sexual assertiveness, sexual inhibition, and sexual deception). We surveyed 594 heterosexual Black women aged 17 to 55 who were undergraduate and graduate students at two universities (one historically Black university and one predominantly White institution). Results confirmed expectations, such that greater media consumption was associated with greater support of traditional gender and sexual roles; in turn, endorsing these roles predicted lower levels of sexual assertiveness, greater sexual inhibition, and more frequent use of sexual dishonesty to retain a partner. We discuss implications of these findings for psychology and sexuality research and also for Black women's sexual relationships.

Heteronormative gatekeeping when enacting queer research in elementary schools: an autoethnographic perspective

Using authoethnography, the authors analyze how queerphobia and cis/heterosexism shape their research process regarding (LGBTQ)-inclusive empirical work in elementary school spaces. With examples from their own experiences, they show how queerphobic gatekeeping affects site access, negotiations required during data collection, and dissemination of the results to others. The authors argue that, taken together, these forces complicate - if not outright prevent - empirical, school-based research with young children, thereby artificially constraining the knowledge base of the field related to LGBTQ-inclusive education. They offer these analyses as affirmations to those facing similar challenges and as education to those in positions of power to change perceptions of, support of, and responses to queer, school-based educational research.

Male Homosexual Preference: Femininity and the Older Brother Effect in Indonesia

Male homosexual preference (MHP) is an evolutionary enigma because it is partially heritable and imposes a fertility cost. In occidental societies, homosexual men are feminized at various levels and they have more older brothers than heterosexual men. To evaluate whether femininity and the fraternal birth order (FBO) effect are universal features of MHP or not, we collected original data from homosexual men, heterosexual men, and heterosexual women from Java (Indonesia). Facial photographs were used to test whether homosexual faces are feminized when compared with heterosexual ones. We found that faces manipulated to resemble the average face of homosexual men are perceived as facially feminized, suggesting that homosexual men are facially feminized compared to heterosexual men, although a higher facial femininity was not captured by morphological analyses. Then, family data were used to detect differences in siblings' composition between homosexuals and heterosexuals. Homosexual men displayed a higher number of older brothers than heterosexual men, even when sibship size was controlled for, suggesting that the FBO effect exists in Indonesian populations. Independent of sexual orientation, men with older brothers seem more feminized than those without older brothers, consistent with the immune origin of the FBO effect. In conclusion, MHP in Indonesia is partially feminized and they have more older brothers. Such features are also associated with MHP in other cultural contexts, suggesting a cross-cultural effect of men homosexual preference. An evolutionary explanation is available for the feminizing effect, although the FBO effect remains unexplained even if proximal mechanisms start to be identified.

Exploring Social Determinants of Health as Predictors of Mortality During 2012-2016, Among Black Women with Diagnosed HIV Infection Attributed to Heterosexual Contact, United States

BACKGROUND

In 2016, black women with HIV infection attributed to heterosexual contact accounted for 47% of all women living with diagnosed HIV, and 41% of deaths that occurred among women with diagnosed HIV in the USA that year. Social determinants of health have been found to be associated with mortality risk among people with HIV. We analyzed the role social determinants of health may have on risk of mortality among black women with HIV attributed to heterosexual contact.

METHODS

Data from the Center for Disease Control and Prevention's National HIV Surveillance System were merged at the county level with three social determinants of health (SDH) variables from the U.S. Census Bureau's American Community Survey for black women aged ≥ 18 years with HIV infection attributed to heterosexual contact that had been diagnosed by 2011. SDH variables were categorized into four empirically derived quartiles, with the highest quartile in each category serving as the reference variable. For black women whose deaths occurred during 2012-2016, mortality rate ratios (MRR) were calculated using age-stratified multivariate logistic regressions to evaluate associations between SDH variables and all-cause mortality risk.

RESULTS

Risk of mortality was lower for black women aged 18-34 years and 35-54 years who lived in counties with the lowest quartile of poverty (adjusted mortality rate ratio aMRR = 0.56, 95% confidence interval CI [0.39-0.83], and aMRR = 0.67, 95% CI [0.58-0.78], respectively) compared to those who lived in counties with the highest quartile of poverty (reference group). Compared to black women who lived in counties with the highest quartile of health insurance coverage (reference group), the mortality risk was lower for black women aged 18-34 years and black women aged 35-54 who lived in counties with the lowest 2 quartiles of health insurance coverage. Unemployment status was not associated with mortality risk.

CONCLUSIONS

This ecological analysis found poverty and lack of health insurance to be predictors of mortality, suggesting a need for increased prevention, care, and policy efforts targeting black women with HIV who live in environments characterized by increased poverty and lack of health insurance.

Hidden in plain sight: Making a case for heterosexual Black college women being identified as a high-risk population for HIV infection

OBJECTIVE

Black emerging adult women (ages 18-25 years) are among the fastest growing demographics of HIV infection, second only to men who have sex with men. Black women account for nine of 10 new HIV cases, whereas 84% of these cases are reported to be from heterosexual contact with infected male partners. Heterosexual Black college women (BCW) have been nearly ignored in the HIV literature despite having shared (e.g., risky alcohol use, multiple and concurrent sex partnerships, and inconsistent condom use) and unique (e.g., segregating dating practices and high sexually transmitted infection rates) risk factors when compared with broader college student demographics.

METHOD

This conceptual paper uses a multiple risk factor framework to underscore shared and unique risk factors that may work to increase the potential HIV infection risk burden in this understudied population.

CONCLUSIONS

Prevention and intervention implications and recommendations for future research that have potential to impact the ways in which colleges, universities, and researchers engage this population are presented. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Regulation and Resistance: Negotiation of Premarital Sexuality in the Context of Migrant and Refugee Women

Constructions of normative sexuality shape the sexual scripts that women are permitted to adopt and the manner in which such sexuality can be expressed. We explored experiences and constructions of premarital sexuality among migrant and refugee women recently resettled in Sydney, Australia, and Vancouver, Canada. A total of 78 semistructured individual interviews and 15 focus groups composed of 82 participants were undertaken with women who had migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. We analyzed the data using thematic decomposition. Across all cultural groups, women's premarital sexuality was regulated through cultural and religious discourse and material practice. Such regulation occurred across three main facets of women's lives, shaping the themes presented in this article: (1) regulating premarital sex-the virginity imperative; (2) regulation of relationships with men; and (3) regulation of the sexual body. These themes capture women's reproduction of dominant discourses of premarital sexuality, as well as women's resistance and negotiation of such discourses, both prior to and following migration. Identifying migrant and refugee women's experiences and constructions of premarital sexuality is essential for culturally safe sexual health practice, health promotion, and health education.

Psychometric Properties of the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales for Men

The dual control model (DCM) postulates the involvement of relatively independent inhibitory and excitatory systems, which together provide a "double control" over sexual response and associated behavior (Janssen & Bancroft, 2007). Based on this model, the Sexual Inhibition and Sexual Excitation Scales assess the propensity for sexual excitation and sexual inhibition. This research focused on analyzing some psychometric properties of this questionnaire and developing a Spanish version in men. The sample consisted of 823 heterosexual men of ages ranging from 18 to 74 years. Confirmatory factor analysis generated a version of the scale that consisted of 34 items (11 items with the worst factor loadings were eliminated) distributed in four factors (one sexual excitation factor and three sexual inhibition factors). This is consistent with the DCM of sexual response. The four factors demonstrated good reliability coefficients except for sexual inhibition due to the threat of performance consequences, which was found to have a low internal consistency. Consequently, this is something that will be addressed in future studies. The four factors were found to have good test-retest reliability. The measures of the Sexual Inhibition and Sexual Excitation Scales had good validity properties and a coherent relationship with sexual sensation seeking and erotophilia.

Willingness to Take PrEP for HIV Prevention: The Combined Effects of Race/Ethnicity and Provider Trust

Blacks and Hispanics/Latinos are disproportionately burdened by HIV compared to non-Hispanic Whites, as evidenced by higher HIV incidence, prevalence, and deaths attributable to AIDS. Increasing the use of novel prevention techniques such as Truvada for pre-exposure prophylaxis (PrEP) could greatly help in reducing these disparities by lowering HIV incidence among these higher risk groups. Trust in providers, which may differ by race and ethnicity, may influence willingness to take PrEP. This study explores the moderating effect of race/ethnicity on trust in one's primary care provider (PCP) on PrEP willingness. This study found a significant association between PCP trust and PrEP willingness, with those with greater trust having 3.24 times the adjusted odds of being willing to try PrEP. Results regarding the effects of race and ethnicity on these outcomes, however, were inconclusive. Results indicate the importance of fostering trust between PrEP-prescribing PCPs and their patients.

Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis

Sexual stereotypes may adversely affect the health of Black men who have sex with men (MSM). Greater understanding of the nature and nuances of these stereotypes is needed. This online, survey-based study used an inductive, intersectional approach to characterize the sexual stereotypes ascribed to Black MSM by the U.S. general public, their distinctiveness from those ascribed to Black men and MSM in general, and their relative prototypicality as compared to dominant subgroups. Members of the public, recruited in 2014-2015, were randomly assigned to survey conditions that varied systematically by race (Black, White, or unspecified) and sexual orientation (gay, heterosexual, or unspecified) of a designated social group. Participants (n = 285) reported stereotypes of their assigned group that they perceived to exist in U.S. culture in an open-response format. Cross-condition comparisons revealed that, overall, Black gay male stereotypes were non-prototypical of Black men or gay men. Rather, stereotypes of Black men were more similar to Black heterosexual men and stereotypes of gay men were more similar to White gay men. Nonetheless, 11 of the 15 most frequently reported Black gay male stereotypes overlapped with stereotypes of Black men (e.g., large penis), gay men (e.g., deviant), or both (e.g., promiscuous). Four stereotypes were unique relative to both Black men and gay men: down low, diseased, loud, and dirty. Findings suggest that Black MSM face multiple derogatory sexual stereotypes, several of which are group-specific. These stereotypes are consistent with cultural (mis)representations of Black MSM and suggest a need for more accurate portrayals of existing sexual diversity within this group.

HIV/STI Prevention Among Heterosexually Active Black Adolescents With Mental Illnesses: Focus Group Findings for Intervention Development

Heterosexually active Black adolescents with mental illnesses are at increased risk for sexually transmitted infections (STIs), including HIV. However, few HIV/STI prevention interventions exist for this demographic. We held seven focus groups (N = 33) to elucidate social, cultural, and psychological factors that influence HIV/STI risk-related sexual behaviors in this understudied population. Seven themes emerged: (a) Blackness and media portrayals, (b) Blackness as a source of cultural resilience and pride, (c) psychosocial determinants of condom use, (d) consequences of engaging in sexual activity, (e) attitudes and beliefs toward sexual behaviors, (f) benefits of sexual activity, and (g) coping mechanisms. Participants also supported the feasibility of and interest in HIV/STI prevention programs integrated with mental health treatment. Transportation, potential breaches of confidentiality, and time were noted barriers to participation. Psychoeducational, skills-based programs are needed to address the sequelae of mental illnesses as they relate to the sexual decision-making process in adolescents.

Unpacking the "Pleasures" and "Pains" of Heterosexual Casual Sex: Beyond Singular Understandings

Discussions of heterosexual casual sex are often imbued with (gendered) assumptions regarding the motives for, and drawbacks of, such a practice. The pulls of casual sex are often depicted as sexual gratification and the drawbacks relayed in terms of physical risk, for example, sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) transmission. Most of the research in this area has largely focused on undergraduate university students or "emerging adults" in North America, using primarily quantitative methodologies. We build on this work and a small but growing amount of qualitative research to unpack the complex psychoemotional and experiential dimensions of casual sex. We report on a critical thematic analysis of interviews with 30 ethnically diverse women and men (aged 18 to 46) in New Zealand about their experiences of heterosexual casual sex to achieve two things. First, we demonstrate the complexity with which women and men discussed their casual sex experiences, highlighting how the practice was varied, contradictory, and multifaceted, and played in a localized way during the conversation. Second, we illustrate how this talk was governed by contemporary Western discourses of intimate relationships and the shape of (gendered) heterosexuality. We conclude that casual sex research must always consider the broader sociocultural context, as well as the interpersonal context, within which any sexual relating is situated.

Recalled Gendered Behavior in Childhood: A Comparison of Androphilic Men, Gynephilic Men, and Androphilic Women in Japan

The current study tested the hypothesis that men who are androphilic (sexually attracted to adult men) in a non-Western, developed country-Japan-would recall engaging in more female-typical behavior, and less male-typical behavior, in childhood, compared to men who are gynephilic (sexually attracted to adult women). Androphilic men, androphilic women, and gynephilic men (N = 302) responded to the Female-Typical Behavior Subscale and the Male-Typical Behavior Subscale of the Childhood Gender Identity Scale, which asked participants to recall their childhood behavior. Results indicated that gynephilic men scored highest on the Male-Typical Behavior Subscale and lowest on the Female-Typical Behavior Subscale. Androphilic women scored the highest on the Female-Typical Behavior Subscale and lowest on the Male-Typical Behavior Subscale. Androphilic men scored intermediately for both the Male- and Female-Typical Behavior Subscales. The results supported the hypothesis that Japanese androphilic men would recall greater gender-nonconforming childhood behavior compared to gynephilic men. These results further reinforce the conclusion that childhood gender-nonconforming behavior is a cross-culturally universal aspect of psychosexual life course development in androphilic men. We discuss why this may be the case, as well as why cross-cultural variation occurs in the magnitude with which recalled childhood gender nonconformity is reported by androphilic males.

Sexual Intimacy Constructions of Heterosexual Couples Living in a Low-Income, "Colored," Farmworker Community in South Africa

This study has been motivated by the scarcity of research that adopts an unproblematic focus on sexuality in South African Black and Colored low-income communities. We explored the sexual intimacy constructions of 15 Colored married/cohabiting couples who live in a low-income, historical South African farmworker community. Using a social constructionist thematic analysis method, we identified four themes: (a) metaphoric and indirect sexual language; (b) the use of a romantic discourse to talk about sexual experiences; (c) male-centered sexual relationships; and (d) lack of privacy brings both restriction and pleasure. We consider how these themes may be linked to the participants' community context and colonial and apartheid history. Finally, we emphasize the need for research that also explores positive sex functions and experiences rather than focuses narrowly on problematic sexual behavior.

'The full has never been told': building a theory of sexual health for heterosexual Black men of Caribbean descent

Research on Black sexual health often fails to represent the heterogeneity of Black ethnic groups. For people of Caribbean descent in the USA, ethnicity is a salient cultural factor that influences definitions and experiences of sexual health. Most research on people of Caribbean descent focuses on the relatively high rate of STIs, but sexual health is defined more broadly than STI prevalence. Psychological and emotional indicators and the voice of participants are important to consider when exploring the sexual health of a minority culture. The purpose of this study was to qualitatively explore how heterosexual Black men of Caribbean descent define and understand sexual health for themselves. Eleven men who self-identified as Black, Caribbean and heterosexual participated in three focus groups and were asked to define sexual health, critique behaviours expertly identified as healthy and address what encourages and discourages sexual health in their lives. Findings point to six dimensions of sexual health for heterosexual Black men of Caribbean descent. These include: heterosexually privileged, protective, contextual, interpersonal, cultural and pleasurable dimensions. There were some notable departures from current expert definitions of sexual health. Recommendations for further theory development are provided.

Gender Nonconformity and Butch-Femme Identity Among Lesbians in China

Previous studies have indicated that the butch-femme identities of lesbian women are related to gender roles (e.g., instrumentality and expressiveness). This study examined the association between butch and femme lesbian identities and gender nonconformity in both childhood (Study 1: 434 lesbian women and 230 heterosexual women) and adulthood (Study 2: 207 lesbian women and 342 heterosexual women) among women in China. In Study 1 (97 femmes, 76 androgynous women, and 264 butches), butches recalled more childhood gender nonconformity (CGN) than did femmes, androgynous, and heterosexual women, and androgynous women recalled more CGN than did heterosexual women. In Study 2 (43 femmes, 44 androgynous women, and 120 butches), butches reported more adulthood gender nonconformity (AGN) based on a "people-thing" dimension of interests than did femmes and heterosexual women, and androgynous women reported preferring more masculine hobbies than did femmes or heterosexual women. There was no significant difference in CGN and AGN between femmes and heterosexual women. These results indicate that femmes are quite similar to heterosexual women with regard to CGN and AGN, thus providing an important extension of previous studies based on a Chinese sample.

The first 30 years of HIV in New Zealand: Review of the epidemiology

AIM

To summarise findings of the epidemiology of AIDS and HIV infection in New Zealand.

METHOD

Key results from reports of AIDS and diagnosed HIV infection are presented. Where appropriate, data on HIV diagnoses are reported for the period 2010-2014 to indicate the current pattern of diagnoses.

RESULTS

New Zealand has a well-described low prevalence epidemic of HIV infection, mostly concentratedin sub-populations of men who have sex with men (MSM), and heterosexual individuals from sub-Saharan Africa and South-East Asia. The former is largely due to transmission within New Zealand, whereas the latter mostly occurred overseas, although the difference has been less marked in recent years. The number of notified cases of AIDS peaked in the late 1980s, and dropped dramatically in the mid-1990s due to the introduction of effective antiretroviral treatments. Presently, most cases of AIDS are in people with previously undiagnosed HIV infection. In contrast, currently the annual number of diagnoses of HIV infection is higher than in the late 1990s, due to more occurring among MSM. Over the past 30 years, each sub-epidemic has demonstrated a distinct pattern, reflecting different determinants. HIV among people who inject drugs, sex workers, children and the general population has been restricted to very low levels.

CONCLUSIONS

Control of HIV in New Zealand is favourable compared to many countries, however challenges remain, especially in prevention among MSM, and more timely diagnosis for all, especially those heterosexually infected. National monitoring of the clinical outcomes of people diagnosed with HIV would provide an indication of the provision of effective care and allow international benchmarking.

Heterosexual Men's Ratings of Sexual Attractiveness of Adolescent Girls: A Cross-Cultural Analysis

Following an identical procedure to the one we previously reported (O'Donnell, Lowe, Brotherton, & Bennett, 2014), we examined ratings of sexual attraction to photographs of (the same) adolescent girls (Tanner stages 3-4) labelled as either 14-15 years or 16-17 years old, women, and men. Ratings were made by Bulgarian heterosexual men by pressing buttons on a response box which recorded the ratings made and the time in milliseconds taken to respond. Despite the age of sexual consent in Bulgaria being 14 years, the pattern of findings did not differ from those found in the UK, where the age of consent is 16 years. That is, mean ratings of the sexual attractiveness of the girls labelled as younger were lower than those of the (same) girls labelled as older, and those of the women. In addition, correlations revealed significantly longer responding times when younger girls (and men) were rated as more highly sexually attractive. These associations were reversed in response to the photographs of women. We take these findings to indicate an inhibitory effect arising from generalized sexual norms relating to the inappropriateness of sexual attraction to young girls; the greater the attraction, the higher the inhibition. This second replication of our initial findings suggests a robust effect that may be of benefit in exploration of pedophile or sex offender groups.

A case of Kaposi sarcoma in an immunocompetent, heterosexual Irish man: a discussion of etiology and viral transmission

Four types of Kaposi sarcoma (KS) have been described, all of which are caused by human herpesvirus-8 (HHV-8).  The incidence of KS in the United States is highest among HIV-positive homosexual men and elderly men of Eastern European, Jewish, or Mediterranean descent. However, few reports describe KS in HIV-negative, immunocompetent heterosexual men in the United States. HHV-8 is transmitted largely via saliva and close sexual contact, whereas there are only a handful of reports of transmission via blood and blood products. We report a case of an HIV-negative, immunocompetent heterosexual man who acquired KS via blood transfusion. A 77-year-old immunocompetent, monogamously heterosexual, HIV-negative Irish man presented with a biopsy-proven KS lesion on the right thigh. Past surgical history included a coronary artery bypass graft, during which he received a blood transfusion from an unknown donor source.  His ecchymotic KS lesions progressed while on doxycycline, intralesional vinblastine, and topical anti-angiogenic medications.  The patient eventually achieved stabilization of KS lesions with acitretin. Our case report emphasizes the need to characterize the phenotype and transmission route of HHV-8 in heterosexual, immunocompetent patients in geographic regions with low HHV-8 seroprevalence.

Diagnoses and Prevalence of HIV Infection Among Hispanics or Latinos - United States, 2008-2013

Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6). To better characterize HIV infection among Hispanics or Latinos aged ≥13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008-2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008-2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed.

Assessing the Gender Invariance of the Modern Homonegativity Scale

The measurement invariance of the Modern Homonegativity Scale (MHS) was examined among heterosexual female (n = 449) and male (n = 329) university students who were predominantly Mexican American. The MHS demonstrated full invariance of factor loadings and partial invariance of latent intercepts. At the latent mean level, heterosexual men compared to heterosexual women held more negative attitudes toward both gay men and lesbian women. There were no latent mean differences in attitudes toward gay men and lesbian women when rated by either heterosexual men or heterosexual women. The MHS can be used by heterosexual men and heterosexual women to assess their homonegativity.

Societal Norms Rather Than Sexual Orientation Influence Kin Altruism and Avuncularity in Tribal Urak-Lawoi, Italian, and Spanish Adult Males

Homosexual males could balance their low fitness by increasing benefits to relatives either through kin-directed altruism or by avuncularity (altruistic behavior toward the children of siblings). Evidence in support of kin selection and avuncularity includes the fact that homosexuals seem to be more empathic and altruistic than heterosexuals. Other studies have not confirmed behaviors that increase kin altruism in homosexuals. We explored altruistic behavior and avuncularity in a sample of 278 subjects, either homosexual or heterosexual, from three populations: Italian, Spanish, and Urak-Lawoi, a Southeast Asian tribal population. Among the Urak-Lawoi, the kathoeys, androphilic men who dress and behave as women, were compared with heterosexuals. All populations were rated for societal norms on the expression of affiliative behavior. No greater kin altruism or avuncularity among the kathoeys or in homosexuals in either Mediterranean population was found. Greater avuncularity and kin-directed altruism, independent of sexual orientation, were found among the Urak-Lawoi, and these traits were the least prevalent among the Italians, corresponding to different societal norms. The increase in kin altruism and avuncularity was associated in all males with societal differences and norms on general altruism toward nonkin children, suggesting it is not an adaptive design to maintain homosexuality in humans.

Racial differences in sexual prejudice and its correlates among heterosexual men

Previous research has consistently found sexual prejudice to be a predictor of antigay aggression and has also revealed specific correlates and antecedents of sexual prejudice. However, extant literature reveals mixed findings about potential racial group differences in sexual prejudice, and few studies have examined racial differences in the correlates of sexual prejudice. The aims of this descriptive study were to determine whether there are (a) racial group differences in reports of sexual prejudice and (b) racial group differences in previously identified correlates of sexual prejudice. Participants were 195 heterosexual males, ages 18 to 30 (98 Blacks and 97 Whites), recruited from a large metropolitan city in the southeastern United States. Based on cultural differences in the influence of religion and in attitudes about male sexuality, it was hypothesized that Black participants would report higher sexual prejudice than White participants. Additionally, based on cultural differences in racial views on masculinity and in sociocultural experiences of male gender roles, it was hypothesized that Blacks would report greater endorsement of religious fundamentalism and the traditional male role norm of status than Whites. Results confirmed all of the hypothesized racial differences and revealed additional differences, including a differential effect of the traditional male role norm of status on sexual prejudice, which explains, at least in part, the racial differences found in sexual prejudice. These findings may reflect underlying cultural differences between Black and White males and may aid in the development of future efforts to reduce sexual prejudice and consequently antigay aggression toward sexual minorities.

Pride and prejudice: factors affecting school attachment among lesbian, bisexual, and heterosexual girls

School attachment is often regarded as a key measure in gauging the integration and wellbeing of students. Previous research suggests that levels of school attachment are generally lower among sexual minority students, but most studies focus on between-gender comparisons and do not conduct within-gender analyses. Using data from the First National Climate Survey on Homophobia and Transphobia in Canadian schools, this study set out to empirically analyze what, if any, differences exist among lesbian, bisexual, and heterosexual female students when assessing the relationship between homophobic and gender-negative language, feelings of safety, harassment/direct victimization, and school climate on school attachment. Bivariate and multivariate findings suggest that there are key differences among female students in terms of school attachment.

Collateral consequences: implications of male incarceration rates, imbalanced sex ratios and partner availability for heterosexual Black women

While studies have found correlations between rates of incarceration and sexually transmitted infections (STIs), few studies have explored the mechanisms linking these phenomena. This qualitative study examines how male incarceration rates and sex ratios influence perceived partner availability and sexual partnerships for heterosexual Black women. Semi-structured interviews were conducted with 33 Black women living in two US neighbourhoods, one with a high male incarceration rate and an imbalanced sex ratio (referred to as 'Allentown') and one with a low male incarceration rate and an equitable sex ratio (referred to as 'Blackrock'). Data were analysed using grounded theory. In Allentown, male incarceration reduced the number of available men, and participants largely viewed men available for partnerships as being of an undesirable quality. The number and desirability of men impacted on the nature of partnerships such that they were shorter, focused on sexual activity and may be with higher-risk sexual partners (e.g. transactional sex partners). In Blackrock, marriage rates contributed to the shortage of desirable male partners. By highlighting the role that the quantity and quality of male partners has on shaping sexual partnerships, this study advances current understandings of how incarceration and sex ratios shape HIV- and STI-related risk.

Community-based program to prevent HIV/STD infection among heterosexual black women

Heterosexual non-Hispanic black women in the United States are far more affected than women of other races or ethnicities by human immunodeficiency virus (HIV). SisterLove, Inc., a community-based organization in Atlanta, Georgia, responded to this disparity early in the epidemic by creating the Healthy Love HIV and sexually transmitted disease (STD) prevention intervention in 1989. Since then, SisterLove has been delivering the intervention to black women in metropolitan Atlanta. This report describes successful efforts by SisterLove, Inc., to develop, rigorously evaluate, and demonstrate the efficacy of Healthy Love, a 3-4-hour interactive, educational workshop, to reduce HIV- and sexually transmitted disease-related risk behaviors among heterosexual black women. On the basis of the evaluation findings, CDC packaged the intervention materials for use by service provider organizations in their efforts to reduce HIV disparities that affect black women in metropolitan Atlanta, the South, and the United States. This report also describes initiatives by SisterLove after the efficacy study to increase the potential effectiveness and reach of the Healthy Love intervention and further address HIV-related disparities that affect black women. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that might be effective in reducing HIV-related disparities in the United States. The results of the randomized controlled efficacy trial highlight the potential of culturally tailored, interactive group intervention efforts to reduce health disparities. CDC's support for evaluating and packaging SisterLove's intervention materials, and making the materials available (www.effectiveinterventions.org) for use by service provider organizations, are important contributions toward efforts to address HIV-related disparities that affect black women.

Conceptualizations of heterosexual anal sex and HIV risk in five East African communities

Heterosexual anal sex is underresearched and little understood, particularly in the African context. Existing prevalence data indicate that heterosexual anal sex is a widespread practice, yet little is known about the way in which it is conceptualized and understood. Describing findings from qualitative research conducted in Kenya, Tanzania, and Uganda, we shed light on conceptualizations of heterosexual anal sex and its relation to human immunodeficiency virus (HIV). These findings suggest that penile-anal sex is practiced by men and women in Africa for a range of reasons, including virginity maintenance, contraception, fulfillment of male pleasure, relationship security, menstruation, in the presence of vaginal complications, financial gain, fidelity, and prestige. Despite anal sex being the most efficient way to transmit HIV sexually, there is widespread lack of knowledge about its risks. These findings describe the ways in which anal sex is conceptualized in five East African communities, highlighting how penile-anal intercourse is often not considered "sex" and how the omission of anal sex in safe-sex messaging is interpreted as meaning that anal sex is safe. In light of its frequency and risks, greater attention must be paid to heterosexual anal sex in Africa to ensure a comprehensive approach to HIV prevention.

Comparative reproductive output of androphilic and gynephilic males in samoa

Debate exists in the behavioral sciences regarding the extent to which androphilic males reproduce compared to their gynephilic counterparts. Quantitative data that might speak to this debate are surprisingly rare. Here, we compared the reproductive output of 235 transgendered, exclusively androphilic Samoan males (known locally as fa'afafine) to that of 447 exclusively gynephilic Samoan males. Samoan gynephilic male participants fathered significantly more children than fa'afafine participants. In fact, none of the fa'afafine in our sample produced offspring. On the basis of this evidence and anecdotal accounts in the anthropological literature, we contend that absence of reproductive output is a near absolute cross-cultural universal characterizing non-Western, transgendered androphilic ("third-gender") males. Models for the evolution of male androphilia must account for how genes associated with this sexual orientation originated in the past and persisted in populations over time despite the fact that the vast majority of androphilic males have no direct reproductive success.

Heterosexual Seduction in the Urban Night Context: Behaviors and Meanings

This article presents an anthropological analysis of heterosexual seduction behaviors of men and women (from 18 to 65 years old, with varying civil status) who attended nightclubs located in the movida areas of Lisbon, Portugal. These behaviors were analyzed according to structure versus communitas theories. Nighttime seduction behaviors were observed and recorded in a field diary, and in-depth semistructured interviews with 60 men and 60 women were conducted. Interviews were analyzed using the thematic content analysis model. Results suggested that the communitas domain was evinced in the various seduction strategies. These courtship behaviors tended to follow a specific pattern: nonverbal seduction, visual seduction, verbal seduction, and acting-consisting of caresses, touches, and kisses. When this escalation process evoked positive responses, it generally culminated in the complete synchrony of movements between the two bodies. The seduction process encompassed both masculine and feminine initiatives: Women engaged primarily in nonverbal and visual seduction, while men appeared to orchestrate verbal courtship and acting. However, sometimes men and women did not want to seduce or be seduced because they were married (especially women) or were with their partners (especially young men) and did not want to endanger the structure domain.

Cognitive aspects of sexual functioning: differences between East Asian-Canadian and Euro-Canadian women

The purpose of this study was to investigate the sexual beliefs of female undergraduates, as well as the thoughts they experience during sexual experiences. The study aimed to determine potential differences in these variables between East Asian-Canadians and Euro-Canadians, as well as the influence of acculturation on these variables. In addition, the relationships between sexual beliefs, automatic thoughts, and specific aspects of sexual functioning were examined. Euro-Canadian (n = 77) and East Asian-Canadian (n = 123) undergraduate women completed the Sexual Dysfunctional Beliefs Questionnaire, the Sexual Modes Questionnaire, the Female Sexual Function Index, and the Vancouver Index of Acculturation. East Asian women endorsed almost all sexual beliefs assessed in this study more than did Euro-Canadian women, and endorsement of these beliefs was associated with acculturation. In addition, East Asian-Canadian and Euro-Canadian women differed in the frequency of experiencing negative automatic thoughts. Results also revealed associations between difficulties in sexual functioning, and both sexual beliefs and automatic thoughts. Together, these results provide preliminary support for the hypothesis that differences in cognitive aspects of sexuality may underlie the differences in sexual functioning previously observed between these two groups.

Heterosexual anal intercourse among men in Long Beach, California

Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.

Differences in testing, stigma, and perceived consequences of stigmatization among heterosexual men and women living with HIV in Bengaluru, India

Approximately 2.4 million people in India are living with HIV. Gender inequality affects HIV prevention, detection, and management. The purpose of this paper was to describe gender differences in the experience of living with HIV in Bengaluru, India. A subsample of n = 313 (159 men and 154 women) from a larger cohort was used for these analyses. Participants were recruited through AIDS service organizations. They completed an interviewer-administered survey assessing HIV testing experience, types of stigma, and perceived consequences of stigmatization. The majority of men (67%) reported getting HIV tested because of illness, while women were more likely to be tested after learning their spouse's HIV-positive status (42%). More men (59%) than women (45%, p<0.05) were tested in private care settings. Men reported significantly higher mean levels of internalized stigma (men: M=0.71, SD = 0.63; women: M=0.46, SD = 0.55; p<0.001), whereas the women reported significantly higher scores for enacted stigma (men: M=1.30, SD = 1.69; women: M=2.10, SD = 2.17; p<0.001). These differences remained significant after controlling for potential socio-demographic covariates. Following their diagnosis, more women reported moving out of their homes (men: 16%; women: 26%; p<0.05). More men (89%) than women (66%; p<0.001) reported to have modified their sexual behavior after being diagnosed. These findings suggest that the experience of living with HIV and HIV stigma varies by gender in this population. Suggestions for a gender-based approach to HIV prevention and stigma reduction are provided.

Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya

African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference −3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART.

Sexual orientation and demographic, cultural, and psychological factors associated with the perpetration and victimization of intimate partner violence among Hispanic men

Hispanics are disproportionately affected by intimate partner violence (IPV). Most of the research describing factors associated with intimate partner violence among Hispanics has focused on Hispanic women or Hispanics in heterosexual relationships. The purpose of this study was to explore the relationship among sexual orientation (heterosexual, homosexual, and bisexual), and demographic, cultural, and psychological factors and intimate partner violence among Hispanic men. A cross sectional questionnaire was administered to 160 Hispanic heterosexual men and men who have sex with men. Demographic factors (age, education, and income), acculturation, depressive symptoms, and self-esteem were assessed using standardized instruments. Data was analyzed using ANOVA, and simple and multiple logistical regression. Differences in education, income, and self-esteem were noted across participants identifying as heterosexual, homosexual, and bisexual. Bisexual Hispanic men had almost four times greater odds of reporting the perpetration of IPV than homosexual Hispanic men, even when differences in education, income, and self-esteem were controlled for (AOR = 3.92, 95%CI = 1.11, 14.19). This study suggests the importance of specifically targeting bisexual Hispanic men in IPV research and services.

Factors contributing to inconsistent condom use among heterosexual men in Curaçao

This study explored, from a public health perspective, factors that contribute to inconsistent condom use by men in Curaçao through semi-structured face-to-face interviews with 21 heterosexual men. The findings show that there is an important disconnect between what is considered culturally appropriate sexual behaviour for men and women and condom use, that diverging from prescribed notions of masculinity and femininity in order to use condoms consistently is difficult, and that condom use is particularly problematic in the context of concurrent partnerships and sexual economic exchanges. Participants further reported that Caribbean family structures, whereby mothers assume the role as primary caregiver and fathers contribute biologically but, to a much lesser extent socially, also have an impact on condom use. Additionally, consistent condom use was reported to be impeded by a cultural taboo on talking seriously about sex and sexual health. In their totality, findings provide important input from men for the development of sexual health promotion interventions that are cognizant of the cultural context in which inconsistent condom use occurs, and that are geared not only to the individual level but also to the interpersonal and structural levels.

A characterization of internet dating network structures among nordic men who have sex with men

BACKGROUND

The Internet has become an important venue for seeking sexual partners and may facilitate transmission of sexually transmitted infections.

METHODS

We examined a 64-day data log of flirt messages expressing sexual interest among MSM within the Qruiser.com community. We used logistic regression to analyze characteristics of MSM sending and receiving flirt messages and negative binomial regression to examine individual activity and popularity. The structural properties, including the core structure of the flirt network, were analyzed.

RESULTS

The MSM population consisted of approximately 40% homosexuals and 37% bisexuals, while the remaining 23% included men who identified as heterosexual but searched for sex with men and "experimental". MSM were more likely to send flirt messages if they were homosexual and aged 40+ years; young people aged < 30 years were more likely to receive a flirt. Possession of a webcam was strongly associated with both sending flirt messages and being a flirt target. The distributions of flirts sent (max k(out) = 2162) and received (max k(in) = 84) were highly heterogeneous. Members in central cores were more likely homosexuals, singles, and aged 31-40 years. The probability of a matched flirt (flirt returned from target) increased from 1% in the outer core to 18% in the central core (core size = 4).

DISCUSSION

The flirt network showed high degree heterogeneity similar to the structural properties of real sexual contact networks with a single central core. Further studies are needed to explore use of webcam for Internet dating.

Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study

BACKGROUND

African American women are disproportionately affected by HIV/AIDS. Concurrent sexual partnerships may contribute to racial disparities in HIV infection. Little is known about attitudes and practices related to concurrency among African American women, or the social, structural and behavioural factors influencing concurrency.

METHODS

We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public clinic in Philadelphia in 2009. We conducted interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioural factors influencing concurrent sexual partnerships, guided by grounded theory.

RESULTS

Seventeen women reported one main and one or more non-main partners; two reported no main partners. Many women used condoms more frequently with non-main than main partners, noting they trust main partners more than non-main partners. Social factors included social normalisation of concurrency, inability to negotiate partners' concurrent partnerships, being unmarried, and not trusting partners. Lack of trust was the most commonly cited reason that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners' dependence on women for economic support and incarceration that interrupted partnerships. Behavioural factors included alcohol and cocaine use.

CONCLUSIONS

Social, structural and behavioural factors strongly influenced these African American women's concurrent sexual partnerships. Many HIV interventions disseminated by the CDC focus largely on behavioural factors and may fail to address the social and structural factors influencing African American women's sexual networks. Novel HIV prevention interventions that address the social determinants of African American women's HIV risks are urgently needed.

Marketing HIV prevention for heterosexually identified Latino men who have sex with men and women: the Hombres Sanos campaign

This article describes the development process of Hombres Sanos, a social marketing campaign to promote HIV testing and condom use for heterosexually identified Latino men who have sex with men and women. The steps included qualitative formative research and a social marketing analytic framework to understand our target audience better, identify incentives and barriers to risk reduction, guide product development, define an optimal promotional campaign, and inform the selection of campaign platforms. A better grasp of the authors' target beneficiaries' needs and values led to an innovative dual strategy for audience segmentation and targeting. The campaign had consumer-centered, culturally sensitive, and theory-driven communication materials. The authors found communication materials and events to be appealing and effective. The campaign was well received among the wider community, and evaluation showed promising results among Latino men in general and among heterosexually identified Latino men who have sex with men and women in particular. The authors provide a step-by-step overview of the project's formative research, including research methods and findings, and how these were translated into a social marketing campaign. In addition, the authors discuss the challenges encountered in this process and the potential of social marketing to reduce HIV risk among Latinos.

Writing the male abuser in cultural responses to domestic violence in Spain

The article analyzes the portrayal of the male perpetrator of heterosexual domestic violence in a selection of contemporary Spanish texts (novel, drama, and autobiography) that form part of a clearly discernible cultural response to the issue of intimate partner violence in Spain today. It reads the figure of the abuser in conjunction with a range of primarily Spanish studies on domestic aggression, with the aim of showing how and why the chosen authors engage with bodies of theory that address battery. The study concludes that some cultural producers devise a strategy of eliding the male aggressor in an attempt to subvert the power he wields over the female victim.

Reflections on sex research among young Bedouin in Jordan: risks and limitations

Research about sexuality is characterised by silences and invisibilities. This is particularly evident in some Islamic Arab societies where discussion of sexuality in general is not encouraged and practices such as homosexuality or pre-marital sex are not acknowledged. This creates a barrier to carrying out sex research and also means that much of the research-based knowledge and methodologies developed in a Western setting may have limited applicability. This paper uses research recently carried out among Bedouin young women in Jordan to examine these limitations and the extent to which research approaches and findings from relatively liberal Western cultures are appropriate and relevant. Following a description of the cultural context in which the study took place, the paper identifies potential risks of conducting sex research in this setting and the research limitations related to this risk. Finally, it addresses the question of whether doing sex research has any value given these restrictions.

Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia

African Americans face disproportionately higher risks of HIV infection. Concurrent sexual relationships, or sexual partnerships that overlap in time, are more common among African Americans than individuals of other races and may contribute to racial disparities in HIV infection. However, little is known about attitudes, norms and practices among individuals engaged in concurrent partnerships. Little is also known about the processes through which structural, behavioral, and social factors influence concurrent sexual relationships. We recruited 24 heterosexual African American men involved in concurrent sexual relationships from a public health clinic in Philadelphia. We conducted in-depth interviews exploring these men's sexual practices; social norms and individual attitudes about concurrency; perceived sexual health risks with main and non-main partners; and the social, structural, and behavioral factors contributing to concurrent sexual relationships. Twenty-two men reported having one main and one or more non-main partners; two reported having no main partners. Respondents generally perceived sexual relationships with non-main partners as riskier than relationships with main partners and used condoms far less frequently with main than non-main partners. Most participants commented that it is acceptable and often expected for men and women to engage in concurrent sexual relationships. Social factors influencing participants' concurrent partnerships included being unmarried and trusting neither main nor non-main partners. Structural factors influencing concurrent partnerships included economic dependence on one or more women, incarceration, unstable housing, and unemployment. Several men commented that individual behavioral factors such as alcohol and cocaine use contributed to their concurrent sexual partnerships. Future research and interventions related to sexual concurrency should address social and structural factors in addition to conventional HIV risk-taking behaviors.

Disparate associations of HLA class I markers with HIV-1 acquisition and control of viremia in an African population

BACKGROUND

Acquisition of human immunodeficiency virus type 1 (HIV-1) infection is mediated by a combination of characteristics of the infectious and the susceptible member of a transmission pair, including human behavioral and genetic factors, as well as viral fitness and tropism. Here we report on the impact of established and potential new HLA class I determinants of heterosexual HIV-1 acquisition in the HIV-1-exposed seronegative (HESN) partners of serodiscordant Zambian couples.

METHODOLOGY/PRINCIPAL FINDINGS

We assessed the relationships of behavioral and clinically documented risk factors, index partner viral load, and host genetic markers to HIV-1 transmission among 568 cohabiting couples followed for at least nine months. We genotyped subjects for three classical HLA class I genes known to influence immune control of HIV-1 infection. From 1995 to December 2006, 240 HESNs seroconverted and 328 remained seronegative. In Cox proportional hazards models, HLA-A*68:02 and the B*42-C*17 haplotype in HESN partners were significantly and independently associated with faster HIV-1 acquisition (relative hazards = 1.57 and 1.55; p = 0.007 and 0.013, respectively) after controlling for other previously established contributing factors in the index partner (viral load and specific class I alleles), in the HESN partner (age, gender), or in the couple (behavioral and clinical risk score). Few if any previously implicated class I markers were associated here with the rate of acquiring infection.

CONCLUSIONS/SIGNIFICANCE

A few HLA class I markers showed modest effects on acquisition of HIV-1 subtype C infection in HESN partners of discordant Zambian couples. However, the striking disparity between those few markers and the more numerous, different markers found to determine HIV-1 disease course makes it highly unlikely that, whatever the influence of class I variation on the rate of infection, the mechanism mediating that phenomenon is identical to that involved in disease control.

Processes of sexual orientation questioning among heterosexual women

Because very little is known about heterosexual identity development, this study assesses and describes sexual orientation questioning processes of heterosexual-identified women and offers a comparison of these processes with those employed by their sexual-minority counterparts. Participants included 333 female college students (ages 18-23; M = 19.2): 228 participants primarily identified as "exclusively straight/heterosexual," and 105 participants indicated a sexual-minority identity. Sixty-seven percent of exclusively heterosexual respondents (n = 154) indicated having thought about or questioned their sexual orientation. The processes by which heterosexual participants described questioning their sexual orientation were coded for the presence of five emergent categories using an inductive thematic coding methodology. These five categories included unelaborated questioning (19%), other-sex experiences (16%), exposure to sexual minorities (26%), assessment of same-sex attraction (48%), and evaluations of same-sex behavior (26%). Several unifying and differentiating themes emerged between sexual orientation groups. Results from this study suggest that contemporary young women's heterosexuality is not necessarily an unexamined identity; indeed, the large majority of young women in this sample were deliberately identifying as heterosexual after contemplating alternative possibilities.

“Hating the sin but not the sinner”: a study about heterosexism and religious experiences among black men

This article explored the religious experiences of nine Black men who are married (to a woman) and have sex with men (BMMSM). These men do not refer to themselves as men on the down low but self-identify as heterosexual. Using data collected in 2005 in South Carolina, the authors examined the complex relationship of homosexuality and the Black Church. Specifically, they examined the notion of coping with same-sex behavior, concealment, and its impact on BMMSM. Findings from the thematic analysis suggest that men found ways to manage their religious traditions and same-sex behaviors. This research presents an opportunity to locate and access a hidden population. The authors found a pervasive experience of growing up in social and family environments that expose them to heterosexism.

Heterosexual anal sex experiences among Puerto Rican and black young adults

CONTEXT

Heterosexual anal sex is not uncommon in the United States, and it poses risk for STDs. However, who engages in it and why are not well understood, particularly among young adults.

METHODS

In 2006-2008, data on sexual health-related topics were collected in surveys (483 respondents) and qualitative interviews (70 participants) with black and Puerto Rican 18-25-year-olds in Hartford and Philadelphia. Bivariate and multivariate analyses of survey data assessed predictors of anal sex with the most recent serious heterosexual partner. Interview transcripts were analyzed for anal sex experiences and reasons for and against engaging in this behavior.

RESULTS

Some 34% of survey respondents had had anal sex; this behavior was more common with serious partners than with casual partners (22% vs. 8%). Black respondents were less likely than Puerto Ricans to report anal sex (odds ratio, 0.3); women were more likely to do so than were men (2.9). In the qualitative cohort, perceptions of anal sex as painful and unappealing were the predominant reasons for not having anal sex, whereas sexual pleasure and, in serious relationships, intimacy were the main reasons for engaging in it. Condom use during anal sex was rare and was motivated by STD or hygiene concerns.

CONCLUSIONS

Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk. Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience.

Reactions of heterosexual African American men to women's condom negotiation strategies

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

'These days virginity is just a feeling': heterosexuality and change in young urban Vietnamese men

This paper argues that young Vietnamese men's beliefs around women's changing sexual identities and habits generate some anxiety around their own heterosexual abilities, while contributing to growing doubts around 'traditional' masculine advantage within sexual relations. It explores this notion in regard to eight Vietnamese men aged 18-30 years, interviewed over 13 months of fieldwork in Hanoi, Vietnam. The paper suggests that young men are increasingly ambivalent about notions of 'gendered morality' in general and the significance of female virginity in particular, because of popular ideas around women's changing sexual behaviours since the economic liberalisation of Vietnam in the late 1980s. However, while such ambivalence might at first suggest a shift toward improved gender and sexual equality, findings reveal that some young urban Vietnamese men construct and reinforce explicitly 'masculinist' gender ideologies by watching heterosexual pornography in groups with male friends or by visiting female sex workers for the purpose of watching their friends have sex. In a time of rapid change around discourses on women, some young men seek to build a stable community and relationships with each other by controlling the terms and practice by which women's bodies are used and consumed.